Nicolas Briez

Publications (5)33.15 Total impact

• Article: Percutaneous radiological gastrostomy in esophageal cancer patients: a feasible and safe access for nutritional support during multimodal therapy.

  Williams Tessier, Guillaume Piessen, Nicolas Briez, Arianna Boschetto, Géraldine Sergent, Christophe Mariette
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  ABSTRACT: BACKGROUND: Percutaneous endoscopic gastrostomy is not widely used in malnourished esophageal cancer (EC) patients because of concerns about its feasibility in frequently obstructive tumors, suitability of the stomach as an esophageal substitute, and potential for metastatic inoculation. A percutaneous radiological gastrostomy (PRG) could be an optimal alternative. METHODS: Experience with PRG among 1,205 consecutive patients presenting with EC from 2002 to 2011 in our department was retrospectively reviewed. PRG was mostly utilized for malnourished patients for whom neoadjuvant chemoradiation was scheduled. The rates of both successful placement and major related complications (Dindo-Clavien ≥III) were analyzed. A matched cohort analysis was constructed in patients who underwent esophagectomy with gastroplasty (n = 688) to evaluate the impact of PRG placement on the suitability of the gastric conduit and on postoperative course. For 78 resected patients with PRG (PRG group), 156 randomly selected controls without PRG (no PRG group) were matched 2:1 for gender, age, ASA grade, clinical TNM stage, and neoadjuvant treatment delivery. RESULTS: PRG placement was planned in 269 (22.3 %) patients mainly with locally advanced EC (63.8 %). PRG placement was feasible in 259 (96.3 %) patients. Sixty-day PRG-related mortality and major morbidity rates were 0 and 3.8 % respectively. For resected patients, the PRG and no PRG groups were comparable regarding perioperative characteristics, except for malnutrition, which was more frequent in the PRG group (P < 0.001). At the time of operation, PRG takedown and site closure were uncomplicated and the use of the stomach was possible in all 78 patients. Despite a higher malnutrition rate at presentation in the PRG group, rates of overall morbidity, and morbidity related to esophageal surgery, were similar between the two groups (P > 0.258). CONCLUSION: PRG is feasible, safe, and useful in nonselected patients with EC and does not compromise the suitability of the stomach as an esophageal substitute in patients deemed to be resectable.
  Surgical Endoscopy 09/2012; · 4.01 Impact Factor
• Source

  Available from: PubMed Central

  Article: Open versus laparoscopically-assisted oesophagectomy for cancer: a multicentre randomised controlled phase III trial - the MIRO trial.

  Nicolas Briez, Guillaume Piessen, Franck Bonnetain, Cécile Brigand, Nicolas Carrere, Denis Collet, Christophe Doddoli, Renaud Flamein, Jean-Yves Mabrut, Bernard Meunier, Simon Msika, Thierry Perniceni, Frédérique Peschaud, Michel Prudhomme, Jean-Pierre Triboulet, Christophe Mariette
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  ABSTRACT: Open transthoracic oesophagectomy is the standard treatment for infracarinal resectable oesophageal carcinomas, although it is associated with high mortality and morbidity rates of 2 to 10% and 30 to 50%, respectively, for both the abdominal and thoracic approaches. The worldwide popularity of laparoscopic techniques is based on promising results, including lower postoperative morbidity rates, which are related to the reduced postoperative trauma. We hypothesise that the laparoscopic abdominal approach (laparoscopic gastric mobilisation) in oesophageal cancer surgery will decrease the major postoperative complication rate due to the reduced surgical trauma. The MIRO trial is an open, controlled, prospective, randomised multicentre phase III trial. Patients in study arm A will receive laparoscopic-assisted oesophagectomy, i.e., a transthoracic oesophagectomy with two-field lymphadenectomy and laparoscopic gastric mobilisation. Patients in study arm B will receive the same procedure, but with the conventional open abdominal approach. The primary objective of the study is to evaluate the major postoperative 30-day morbidity. Secondary objectives are to assess the overall 30-day morbidity, 30-day mortality, 30-day pulmonary morbidity, disease-free survival, overall survival as well as quality of life and to perform medico-economic analysis. A total of 200 patients will be enrolled, and two safety analyses will be performed using 25 and 50 patients included in arm A. Postoperative morbidity remains high after oesophageal cancer surgery, especially due to major pulmonary complications, which are responsible for 50% of the postoperative deaths. This study represents the first randomised controlled phase III trial to evaluate the benefits of the minimally invasive approach with respect to the postoperative course and oncological outcomes in oesophageal cancer surgery. NCT00937456 (ClinicalTrials.gov).
  BMC Cancer 01/2011; 11:310. · 3.01 Impact Factor
• Article: Oesophagogastric junction adenocarcinoma: which therapeutic approach?

  Christophe Mariette, Guillaume Piessen, Nicolas Briez, Caroline Gronnier, Jean Pierre Triboulet
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  ABSTRACT: Gastric and oesophageal cancers are among the leading causes of cancer-related death worldwide. By contrast with the decreasing prevalence of gastric cancer, incidence and prevalence of oesophagogastric junction adenocarcinoma (OGJA) are rising rapidly in developed countries. We provide an update about treatment strategies for resectable OGJA. Here we review findings from the latest randomised trials and meta-analyses, and propose guidelines regarding endoscopic, surgical, and perioperative treatments. Through a team approach, members from all diagnostic and therapeutic disciplines, such as gastroenterologists, surgeons, oncologists, radiologists, and radiotherapists, can effectively administer a range of treatment modalities.
  The lancet oncology 11/2010; 12(3):296-305. · 14.47 Impact Factor
• Article: The number of metastatic lymph nodes and the ratio between metastatic and examined lymph nodes are independent prognostic factors in esophageal cancer regardless of neoadjuvant chemoradiation or lymphadenectomy extent.

  Christophe Mariette, Guillaume Piessen, Nicolas Briez, Jean Pierre Triboulet
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  ABSTRACT: To investigate whether the number of lymph nodes metastasis (LNMs) and the ratio between metastatic and examined lymph nodes (LNs) are better prognostic factors when compared with traditional staging systems in patients with esophageal carcinoma. The accuracy of the 6th UICC/TNM classification is suboptimal, especially when not taking into account neoadjuvant therapy and lymphadenectomy extent. For 536 patients who underwent curative en bloc esophagectomy, in whom 51.5% (n = 276) received neoadjuvant chemoradiation, LNMs were classified according to the 6th UICC/TNM classification and systems based on the number (< or =4 and >4) or the ratio (< or =0.2 and >0.2) of LNMs. Survival of the respective stages, predictors of survival, and influence of both chemoradiation and number of examined LNs were studied. After a median follow-up of 50 months, the 5-year survival rates were 47% for the entire population, significantly poorer for patients with >4 LNMs (8% vs. 53%, P < 0.001) or a ratio of LNMs >0.2 (22% vs. 54%, P < 0.001). After adjustment for confounding variables, a number of LNMs >4 and a ratio of LNMs >0.2 were the only predictors of poor prognosis. The prognostic role of both the number and the ratio of LNMs was maintained whether patients received neoadjuvant chemoradiation or not. Moreover, LN ratio is shown to be more accurate for inadequately staged patients (<15 examined LNs), whereas the number of LNMs is pertinent for adequately staged patients (> or =15 examined LNs). Staging systems for esophageal cancer that use the number (< or =4 or >4) and the ratio (< or =0.2 or >0.2) of LNMs have greater prognostic importance than the current staging systems because of the good stratification of the groups and their clinical utility, taking into account neoadjuvant therapy and lymphadenectomy extent.
  Annals of Surgery 03/2008; 247(2):365-71. · 7.49 Impact Factor
• Article: Patients with locally advanced esophageal carcinoma nonresponder to radiochemotherapy: who will benefit from surgery?

  Guillaume Piessen, Nicolas Briez, Jean-Pierre Triboulet, Christophe Mariette
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  ABSTRACT: In patients who are nonresponders to primary radiochemotherapy (RCT), prognosis is poor, leading mostly to palliation. Salvage surgery may have a survival benefit otherwise complete. Our aim was to identify predictors of R0 resection in these patients. In 98 nonresponders with locally advanced infracarinal tumors, curative salvage surgery was attempted. Resection was R0 in 62.2% and incomplete in 37.8% of cases. Univariate and multivariate analyses included pre-RCT and post-RCT variables collected prospectively. Overall survival was higher in the R0 resection group (18.4 vs 8.6 months, P < .001). Independent predictors of R0 resection were tumor height <or= 5 cm on barium swallow (P = .045) and aortic contact <or= 90 degrees on computed tomography (P = .039) evaluated after RCT. Three groups of patients were constructed: 1, tumor height <or= 5 cm with aortic contact <or= 90 degrees (n = 43); 2, tumor height between 6 and 10 cm with aortic contact <or= 90 degrees (n = 32); and 3, aortic contact > 90 degrees , irrespective of tumor height (n = 23). Rates of R0 resection were 81%, 53%, and 39%, respectively (P = .001). Salvage esophagectomy should be systematically attempted in nonresponders with tumor height <or= 5 cm on barium swallow and aortic contact <or= 90 degrees on computed tomography and discussed case by case for other patients.
  Annals of Surgical Oncology 07/2007; 14(7):2036-44. · 4.17 Impact Factor